“When are you going to have a baby?”

I get asked this question pretty much on a daily basis in Shanghai by the lady at the vegetable shop, taxi drivers, Chinese acquaintances and even expat friends, who are so used to the question themselves that they have forgotten that it’s somewhat taboo in Western culture.

My answer for the last four and a half years: “When we move back to Australia.”

A large part of the reason is because we’re so far away from family here, but my background as a pharmacist and personal experiences, including a Western clinic failing to diagnose my husband’s torn ligament, have left some doubt in my mind about the level of health care that is available in China. My reservations about having a child in China have also been heightened by widespread coverage of the former head of the State Food and Drug Administration receiving a death sentence in 2007 due to bribery and the 2008 melamine-tainted milk scandal. Then there’s the bad air quality, which has plagued Shanghai following the close of the World Expo in October.

But it’s been baffling me that there has been a noticeable expat baby boom in China, which prompted me to investigate things a little further. Full-time help from an ayi and the bub growing up fluent in two languages aside, perhaps health standards in China are comparable to those back home.

“I’m very confident in both the private health care system in Shanghai and the public health care system in Australia and if I were planning to have any more children, I would be happy to have them in either place,” says Emma Roseby, who had daughter Layla at the American-Sino OB/Gyn Service (affiliated with Shanghai’s Huashan Hospital) in China in 2008, and her second daughter Genevieve in Bendigo, Victoria earlier this year.

According to another mum, Rae Walters, who had her first baby boy, Finn, in Beijing and her second boy, Rupert, in Sydney, both the private Chinese and public Australian health systems have their advantages and disadvantages.

“Having a baby in China, especially your first, is a leap of faith in some respects but the care that I received was absolutely amazing,” she says.

Ms Walters gave birth prematurely to Finn, who was admitted into the neonatal intensive care unit at privately-run Beijing United Family Hospital.

“He received one-on-one nursing care around the clock, which is something that would never happen in Australia due to the lack of resources,” she says.

Almost one in two births in China are delivered via Cesarean section, which far exceeds the rate of 15 percent recommended by the World Health Organization. Reasons for the high rate include economic factors and more “controllable” deliveries to avoid medical disputes.

Two of the three Australian mums I interviewed had C-section deliveries.

Ms Roseby also describes communication with her doctor in China as “slightly problematic at times”, although this does vary between individual doctors. She also says that post-birth pain management was better handled in Australia compared to China, as Chinese nurses held more traditional views regarding painkillers.

Both Ms Roseby and Ms Walters add that pre- natal checkups in China including tests and scans were more frequent.

“They are a bit overzealous with scans, however, I think it has more to do with generating revenue than doctors being unsure of their own judgment,” Ms Walters says. “They tend to push the envelope for certain things because most women tend to be covered by health insurance.”

“Giving birth through a foreign or Sino-foreign clinic in China is very expensive and is unaffordable for most people unless covered by health insurance,” says Karen Surmon, who has given birth to two babies in China, daughter Blake at Amcare Women’s & Children’s Hospital in Beijing and second daughter Madeleine at Shanghai’s American- Sino Ob/Gyn Service.

Ms Surmon also notes that there is a vast difference between the cost of pediatric services in Beijing and Shanghai. “Immunisation costs for children are also substantially more expensive in Shanghai than Beijing, although foreign-imported vaccinations are available,” she says.

All three women had either partial or full health insurance coverage and Ms Surmon and Ms Roseby estimate a minimum cost of around RMB 60,000 from pregnancy to delivery in China, while Ms Walters’ bill in Beijing came to A$60,000.

According to Ms Surmon, another advantage of having a baby in Australia is that the public health care system provides for home visits by nurses and access to 24-hour support hotlines, which is unavailable in China.

So, researching this story has opened my eyes to the fact that supply and demand forces has meant more attention is paid to maternal services than other health services in China. This means that having a baby in China through the private system is something that isn’t just for the brave- hearted, and the next time the lady at the vegetable shop asks me when I’m having a baby, perhaps I’ll have a different answer for her, much to her delight! ■